PAA APPLICATION FORM
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Name _______________________ Wife’s Name ___________________
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Street ________________________________________________________
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City ____________________ State _______________ Zip _____________
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Telephone (______)___________________ Date _____________________
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Costs
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Initiation Fee $ 5.00
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Annual Dues $15.00
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Total $20.00Please Complete Form and Send to:
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Pioneer Auto Association
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PO Box 1971
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South Bend, In. 46634Signature of Applicant _____________________________________
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Recommended By ___________________________________________
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List Antique or Classic Autos Owned: (list additional cars on back)
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Make Model Year Condition
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1. ______________ ___________ _________ ________________
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2. ______________ ___________ _________ ________________
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3. ______________ ___________ _________ ________________
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4. ______________ ___________ _________ ________________
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5. _____________ ___________ _________ ________________
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6. ______________ ___________ _________ ________________
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Other Auto Interest: (list on the back)
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